Minerva anestesiologica
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Minerva anestesiologica · Aug 2016
ReviewNeurally Adjusted Ventilatory Assist (NAVA) in children: a systematic review.
Application of mechanical ventilation in spontaneously breathing children remains a challenge for several reasons: mainly, small tidal volumes and high respiratory rates, especially in the presence of leaks, interfere with patient-ventilator synchrony. Leaks also cause unreliable monitoring of respiratory drive and respiratory rate. Furthermore, ventilator adjustment must take into account that infants have strong vagal reflexes, demonstrate central apnea and periodic breathing, with a high variability in breathing pattern. Neurally-adjusted ventilatory assist (NAVA) is a mode of ventilation whereby the timing and amount of ventilatory assist is controlled by the patient's neural respiratory drive. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized assist, both invasively and non-invasively (NIV-NAVA), to follow the variability in breathing pattern, and to monitor patient respiratory drive, independent of leaks. ⋯ Evidence from a few trials suggests improved comfort, less sedation, and reduced length of stay.
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Minerva anestesiologica · Aug 2016
The Impact of patient controlled analgesia on prognosis of patients receiving major abdominal surgery.
Postoperative pain is a major disease burden after surgery. Patient-controlled analgesia has been wide used for pain management in surgical patients, yet, large-scaled studies are lacking to assess its impact on the prognosis of patients. ⋯ Intravenous patient-controlled analgesia was related to improved survival, less complications and chronic post-surgical pain after major abdominal surgery, reiterating the important role of pain management for the prognosis of patients who underwent surgery.
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Minerva anestesiologica · Aug 2016
Editorial CommentPatient-controlled analgesia: past, present and future.
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Minerva anestesiologica · Aug 2016
Comparative StudyInfluence of supraglottic airway device placement on cerebral hemodynamics.
Supraglottic airway devices (SGDs) are of current use in anesthesia practice and in emergency conditions. It has been suggested that cerebral blood flow (CBF) can decrease after SGD insertion or cuff inflation; however, it is uncertain if this reduction is caused by the SGD or the anesthetic drugs utilized for the anesthetic procedure. During minor surgery we separated CBF measurements by an adequate time interval in order to measure the distinctive changes in cerebral hemodynamics associated with anesthesia induction, SGD insertion and cuff inflation. ⋯ SGD insertion and cuff inflation did not influence cerebral hemodynamics in anesthetized patients undergoing minor surgery. At normal etCO2 range, the CBF reduction with transient increase in PI was associated with anesthesia induction and not SGD insertion itself.